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目的探讨18F-FDG PET/CT与增强CT对肝癌栓塞治疗后的疗效评估价值。方法回顾性分析2009年9月～2012年3月期间在我院接受动脉导管栓塞化疗(TACE)并接受PET/CT检查的28例原发肝细胞癌患者的临床及影像学资料;将肝动脉栓塞治疗后4～5 w的PET/CT检查结果,增强CT结果与AFP值对照分析,判断病灶内是否有肿瘤残留或复发。结果本组28例中24例与AFP进行对照,其中11例治疗后AFP降低到正常水平,5例18F-FDG PET/CT与增强CT显示肿瘤区域见不同程度的碘油聚集,未见异常强化影和FDG浓聚影;6例CT可见异常强化影,未见异常FDG聚集,考虑强化影可能为再生结节或炎性肉芽组织。治疗后AFP未降到正常水平13例,其中7例见不同程度碘油聚集,CT增强见结节及斑片强化影,FDG异常聚集;6例FDG异常聚集,CT未见异常强化。3例患者治疗前、后AFP均正常,TACE治疗后4 w行增强CT扫描见碘油聚集边缘有结节样强化,CTA可见异常血管影,18F-FDG PET/CT可见斑片状摄取增高影,经穿刺活检证实为肿瘤复发。1例肝右后上叶巨块型肝癌,治疗前后AFP均正常,CEA升高,18F-FDG PET/CT检查在碘油聚集的边缘可见异常FDG摄取,CT增强未见异常强化,经穿刺活检证实为肿瘤复发。结论18F-FDG PET/CT显像结果与AFP对照其在判断肝细胞癌动脉栓塞治疗后复发和转移上明显高于CT增强扫描。
Objective To evaluate the value of 18F-FDG PET / CT and contrast-enhanced CT in evaluating the curative effect of hepatocellular carcinoma after embolization. Methods The clinical and imaging data of 28 patients with primary hepatocellular carcinoma undergoing arterial catheter chemoembolization (TACE) and receiving PET / CT in our hospital from September 2009 to March 2012 were retrospectively analyzed. The hepatic artery 4 ~ 5 w PET / CT examination results after thromboembolism treatment, enhanced CT results and AFP value control analysis to determine whether the tumor residual tumor or recurrence. Results In the group of 28 cases, 24 cases were compared with AFP, of which 11 cases were treated with AFP reduced to normal levels, 5 cases of 18F-FDG PET / CT and enhanced CT showed tumor area see varying degrees of lipiodol accumulation, no abnormal enhancement Shadow and FDG concentration shadow; 6 cases of CT showed abnormal enhancement shadow, no abnormal FDG aggregation, consider enhancement shadow may be regenerative nodules or inflammatory granulation tissue. After treatment, AFP did not fall to normal level in 13 cases, including 7 cases of varying degrees of lipiodol accumulation, enhanced CT seen in nodules and patch enhancement, abnormal FDG accumulation; 6 cases of FDG abnormal aggregation, CT no abnormal enhancement. 3 patients before and after treatment, AFP were normal, 4 weeks after TACE enhanced CT scan found lipiodol edge of nodular enhancement, CTA showed abnormal blood vessels shadow, 18F-FDG PET / CT shows increased patchy , Confirmed by biopsy tumor recurrence. One case of hepatocellular carcinoma with right upper lobe and posterior upper lobe had normal AFP and CEA before and after treatment. Abnormal FDG uptake was observed on the edge of lipiodol accumulation by 18F-FDG PET / CT. No abnormal enhancement was observed on CT enhancement. Confirmed as tumor recurrence. Conclusion 18F-FDG PET / CT imaging results and AFP control in evaluating the recurrence and metastasis of hepatocellular carcinoma after arterial embolization was significantly higher than the CT enhanced scan.